Ultrasound Guided Musculoskeletal/Neuro Injections

What is a Steroid Injection

  • Cortisone (steroid) shots are injections that can help relieve pain and inflammation in a specific area of your body. They're most commonly injected into joints — such as your ankle, elbow, hip, knee, shoulder, spine or wrist. Even the small joints in your hands or feet might benefit from cortisone shots.

What is an OnabotulinumtoxinA (Botox) Injection 

  • Botulinum toxin type A (BoNT-A) injection reduces muscle bulk as well as muscle contracture, pain, and associated nerve compression. 

What are the risks?

  • Risks can include

  • Bleeding/ Bruising

  • Temporary facial flushing

  • A temporary flare of pain and inflammation in the joint

  • Temporary increase in blood sugar

  • Tendon weakening or rupture

  • Thinning of nearby bone (osteoporosis)

  • Thinning of skin and fat around the injection site (cosmetic issue)

  • Whitening or lightening of the skin around the injection site

  • Cartilage damage

  • Joint infection

  • Nerve damage

How to Prepare

  • Tell your doctor if you've had a temperature of 100.4 F (38 C) or greater in the previous two weeks.  If you experience redness or swelling in the area to be injected, we recommend waiting until the symptoms have resolved before injection.
  • Please refrain from taking any medications that alleviate anxiety beforehand, with the exception of Tylenol and Advil. This includes any pain or anti-anxiety medications that may have been prescribed to you in preparation for this procedure. Please bring necessary medication with you. There will be an opportunity to take your medications in a timely manner, after you have met with the radiologist to discuss the risks and benefits of the procedure.  

For Steroid Injections

  • Refrain from Covid vaccine up to 2 weeks prior to steroid injection

  • Speak with your OBGYN if you are or may be pregnant before proceeding with the steroid injection 

For Botulinum toxin type A (Botox) Injections

  • Botox is not recommended for women who are pregnant or may be pregnant anytime during her gestation. Please speak with your OBGYN for special exceptions.

For Lower Extremity Injections

  • For all foot, ankle, or leg injections, please come with a designated driver, as some patients experience foot numbness for up to 4 hours after the injection.

What should I expect during the procedure?

  • The duration of the procedure is usually 1 hour. 
  • The area around the injection site is cleaned. Your doctor will inject anaesthetic (lidocaine) to numb the area where the needle will be inserted. Your doctor will use ultrasound to guide the needle's progress inside your body — so as to place it in the right spot.
  • You'll likely feel some pressure when the needle is inserted. Let your doctor know if you have a lot of discomforts. The medication is then released into the injection site. Typically, cortisone shots include a corticosteroid medication to relieve pain and inflammation over time and an anesthetic to provide immediate pain relief.

What should I expect during recovery?

  • You may shower as soon as you want after the procedure (No bath or hot tub for 48h).
  • Leave the bandage on for 24 hours and then remove
  • After the procedure, you may take your routine medications and any prescribed pain medicines. Ice packs or heat may be helpful if you have pain and soreness at the site. 
  • For Steroid injection only: Your pain may take a couple of weeks to improve after the procedure. The local anesthetic or numbing medicine only works for a few hours. The steroid typically takes 2-5 days to work, though some may not notice a change for one or two weeks. Some patients may have more joint pain the day after the procedure than they did before. This is called a pain “flare.” If this happens, limit activity and take your prescribed pain medications. Both Tylenol and icing of the joint may help. Most pain flares resolve without additional intervention.

Call your provider if you experience:

  • Fever (100.4oF or greater) in the 10 days following the procedure.
  • If there is persisting pain, increased redness, or swelling at the site, this could be a sign of infection. Other signs of infection include fever greater than 100.4 F (taken by mouth) or drainage from the injection site.  

Frequently Asked Questions

  • Can I eat before the procedure: Yes, you can eat and drink as per usual.

  • Should I take my regular medications: Yes, Please take all medication as per usual.